Signs of MS may start five years before diagnosis

Canadian research shows people with MS are more likely than the general population to visit a doctor or hospital in the years leading up to an MS diagnosis.

Last updated: 30th August 2018

It is becoming increasingly clear that diagnosing and treating MS as early as possible is associated with better long term outcomes for people with MS. However, recognising the very earliest signs of MS can be very challenging.

MS is usually diagnosed following at least one episode of neurological symptoms (known as a first demyelinating event), together with MRI scan results that indicate both new and old lesions in the brain or spinal cord.

A number of recent studies have suggested that people with MS may also show increased use of health services in the years before a clearly defined first neurological episode, suggesting that there might be additional warning signs for the onset of MS.

Now, Canadian researchers have conducted a large study to more clearly demonstrate this and define the signs and symptoms that might be associated with an impending MS diagnosis. The researchers, based at the University of British Columbia and led by Professor Helen Tremlett, examined the health records of nearly 14,000 people with MS from four Canadian provinces between 1984 and 2014 and compared them to the health records of nearly 67,000 people who did not have a diagnosis of MS.

The results, recently published in the Multiple Sclerosis Journal, showed that, in the five years before a first demyelinating event, people with a diagnosis of MS had attended hospital or visited a doctor more frequently than those without MS. The visits involved symptoms of the nervous, sensory, musculoskeletal and urinary systems of the body. They were also more commonly prescribed medications to treat musculoskeletal, nervous system, gut, metabolism, genito-urinary systems and sex hormones symptoms (esuch as contraception and fertility medications).

Visits to psychiatrists and reports of headaches and mental health conditions were also higher among the people who were later diagnosed with MS.

UK study

Another recent UK study, published in the Annals of Neurology, showed that a similar range of symptoms were more common in people with MS in the 10 years prior to diagnosis.

Other conditions such as Alzheimer’s disease and Parkinson’s disease have previously been shown to have a collection of very early signs and symptoms that are not necessarily considered to be classic symptoms of the onset of these conditions. This collection is known as a ‘pro-drome’ and has helped to identify people at risk of developing these conditions as well as supporting clinical trials that try to stop the full development of the disease.

Traditionally, MS was not considered to have a pro-drome, or to have a collection of early signs and non-MS specific symptoms. However, this work and other studies have shown that, looking collectively at people with MS, it is possible to identify clues that may point to a diagnosis of MS.

More work is needed in order to more clearly identify the pro-drome. However, once it is better defined, raising awareness of this among a range of specialist doctors – not just neurologists, but also urologists, ophthalmologists and psychiatrists – could help to trigger the necessary tests and investigations that can identify whether or not someone has MS at an earlier stage.